Taking a proactive approach while coding spine and pain procedures will maintain compliance while maximizing revenue in the ASC setting.
Coding spine and pain procedures can be a complex and confusing process for both new and veteran coders.
During a June 6 webinar sponsored by National Medical Billing Services and hosted by Becker’s Healthcare, three revenue cycle experts from National Medical Billing Services — Lisa Rock, President; Tamara Wagner, Vice President of Coding Compliance; and Alison Kuley, Senior Spine Coder —shared five tips for ASCs to improve compliance and maximize revenue when coding for common spine and pain procedures.
The most-common spine and pain procedures currently performed in ASCs are:
- Lumbar decompression
- Lumbar discectomy
- Anterior cervical discectomy and fusion
- Lumbar posterior inner-body fusion
- Spinal cord stimulator
- Radiofrequency ablation
Here are five tips from the presentation:
- Coders should have a strong understanding of spine anatomy. Different surgical approaches, incision types and surgical methods correspond to different CPT codes and reimbursement levels. Coders who have a strong understanding of spine anatomy are well-positioned to choose the appropriate codes each time. “You need to know the area the physician is working in to determine his approach, level assignment and the correct CPT and diagnoses assignments for those particular procedures,” Ms. Kuley said. “Obtaining proper and accurate information [from the surgeon] could be the difference between billing one level or multiple levels.”
- Code for all levels of lumbar decompression. Ms. Kuley recommends coders carefully review the operative report to determine exactly how many nerve roots or levels were decompressed to code for all appropriate levels. If this is not clear in the operative report, the coder should query the physician.
- Identify the presenting diagnosis in surgeries with both lumbar discectomy and decompression. “A lot of times, a patient will have both stenosis and disc herniation,” Ms. Kuley said. “According to CPT, you code for the diagnosis. … You really want to look for presenting diagnoses of these patients.” If herniation is the root problem, coders can code for a discectomy. However, if the stenosis is the problem, coders can typically code for a decompression.
- Know the implants used in fusion surgeries. “With spine coding infusions, knowing what types of implants the physician used is very important because implants are covered under specific CPT codes,” Ms. Kuley said.
When it comes to identifying and coding for fusion procedure implants, Ms. Kuley shared four key elements that drive coding:
- Identify whether the spacer made from titanium, PEEK or bone.
- Identify it the surgeon used a standalone cage, as these include integrated hardware for anchoring the device.
- Determine whether the implant has a separate plate and screws, as these require additional CPT codes.
- Code for whether it is a first-time implant, removal or revision surgery.
- Code radiofrequency ablation procedures according to the latest guidelines. In 2012, the CPT codes for RFA procedures changed, as well as RFA billing guidelines. Facet joint RFA procedures are no longer billed per nerve but are billed per facet joint level. “You’d be amazed how many doctors I talk to regularly who are unaware you can’t bill per nerve, that it has to be per facet joint level,” Ms. Wagner said. Coders who stay updated on the latest regulatory billing and coding guidelines, as well as changes in payers’ individual medical policies, are more likely to see claims approved on the first submission — a major boon to an ASC’s bottom line.
Source: Becker’s ASC Review
This post was first published June 22, 2018 and was updated July 29, 2020.